Anterior ankle impingement arthropathy. The role of anterolateral arthrotomy and arthroscopy.

The choice of anterior ankle arthroplasty conducted by anterolateral arthrotomy versus arthroscopic techniques depends on the severity of the osteophytosis and the dominance type. This can be determined in most cases by conventional radiology, contrast arthrography, or MRI. Diagnostic arthroscopy may be required when noninvasive means fail to provide the answer to anterior frontier joint pain. Thorough arthroplasty must be performed and the joint placed through its end range of motion to verify reduction of all impingements. Extensive bony impingements are most effectively treated by conventional anterolateral arthrotomy. This is particularly true in posttraumatic cases with considerable arthrofibrosis infiltrate. Lesser degrees of osteophytosis confined, in particular, to the leading tibial edge are effectively reduced by arthroscopic technique. Anterior ankle arthroplasty by either technique offers symptomatic relief of pain with minimal morbidity. It can serve as a definitive treatment protocol for many patients or simply represent a temporary step along the way to more aggressive salvage surgery such as arthrodesis.